N0719 GWALTNEY ROAD

Department of Environment,
Health and Natural Resources
Division of Solid WC010 Management
James B. Hunt, Jr., C-ovelhof
Jonathan B. Howes. Secretary
r.i
William L Meyer, Director FILED BUR Ef COUNTY NC G%�7
07/27/2000 9:23 AM
_ ELIZABETH COOPER
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION R ister Of DA
Pursuant to i 5A NCAC 138 .0663(2)(al, the land ownerls) and operator(s) of any Land arrngr &puuJty A
Inert Debris Landfill under two (21 acres In size shall submit this notification form to the Division Drior
to constructing or operating the landfill. This form must be filed for recordation in the Register of
Deeds' Office. The Register of Deeds shell Index the notification under the name of the owner(s) of the
land in the county of countlif In Which the Idnd is located. The Register's seal and the date, book, and
page number bf recording Muet be Includdd on this form when submitted to the Division. This
�d .. I& «nt U to out ndra eneration of a landfill unless complete, accurate, recorded, and
submitted td tha Division it required by 15A NcAc 139.0553(2)lbl.
Facility NAme:'�_
Facility location (street
City:
Directions to Site.
6i1 Cnunty: ��
w
Zip•
The land on which this landfill IA located is described in the deed recorded in:
- -deed book: pane: county
Nam@ of land owner..
Mailing a,�,d��dress of lend owner: `%LS/6 tF4�.rtT,,.ty
City: /�'�KmUal wLl _State: N � Zip:
Telephone number of land 6wner.( XZ i 1 YJ 34?d l
Ii the land is owned by more than one person, attach additional sheets with the name, aadress,
and phone number of all additional land owners.
8. Name of operator:
8. Trade or business name of operator: %� tC , AT
to Mailing address of operator: r�) I (o f C Tlr,.l /i'B)ssa_ (%+1u+•o'r-t.4 kI-ey
Ciri• State: %%. C Zip• 7- V, S S
If the landfill is operated by ,Wore than one na•^„• • addiuonal sheets with the name,
address, and phone number of all additional operator§.
12. Projected use of land attar completion of landfill operations• ,+Ay�w
P O. Eox 276c7. Rc!eich. Merih Ccrcl'�na.27611-iboi Telechcne 919-iS3•d;;6 F-'< ^,1S•;1 -=CCS
� • An'e� wCeee^..rah/.'•,:lmerivbAc'icnfinerc•ler ECa ac/c'ed!1Cecc:'c_^:.: erccce•

'a
J
,# '
I61
171
181
191
1101
It Il
Itil
1131
h al
1151
1t61
e_ _-r me.�r.
ftlilrlM irealgn mmt b1 ICegmplished within ]0 wa Nng does or I27 estrnnr dsys ir_n
ehfinl, bland, Ildeel. ltt. to prevent unwthodsed access escnt when a..
n r ou6Lc us q assu�wrth
eperltlenll rMukirn/r:l Ind td bWM! IbliAllnbl df tanlutndritld wlstl/
AaU! rtlid! Ih1A!1 it IA-kllihb ldhllhklkn Ind rxopedy munotned.
Sur11d 6/lb IhY tll /nld hdh tAl d+mllnp Iles Ind ahaA net be Impaundid ever waste
qe w au Ma net ba OlaO W siIIM.
n.
pa ear,e n e , env pu a,µlr/Hd tly th1 IacPoty shah not 1xel/d•
let twiner -art eNedrd tH Lh1 bwk Aa61es1y1 Am11 rer ehl paler In 1lealty ftmetures
lbl thl I/wir /selmivl ImR iM Ihl p1lll It tha preparty boundary
l!leh/U ihll tll AfnkM fttwpltLdn dtl dreuph thl usa of turrint brat management prac•Ices
tum � tlieaetfl with 8♦ ImdN wltlf menikgdnp, dr both, maybe regmred as Drovided for under nuln
0 ul a a sra uccvp.lf
A sign lhiA tl1 pestle 1! th/ NeA1N Intllnel Ihewlnp thl CdnuC. mm1 Ind number In ease or an emngenc/ and :he pemn number
ThI r7ermk mohair rao4lrlmird N Alt Ipp11a611 Ia Iac91tIN not rtouldnp m Individual perms
Certification by Lehd Owner:
I�certitY that the Iniorr:tation prdvidld by m! in this notlilcatlon is true, accurate, and cornplera to the
best of my knowledge. The facility llting end disposal operatlon9 0l this Land Ciearina &Inert Debris
landfill will com 1 With the flQulflMentl of Section9 .0563, .0564 and 050"6 of 15A NCAC 138,
North Carotin! Solid Wllte M!h!gltnent Ruler, The facility end operations of this landlill will also
comply With !Il 1ppnt:l91! Fedltll, Still, !nd Local IAwl, rule!, tegulations, and ordinances. Where the
operator 1! dllilflHt fttlh1 th! Ilnd tltNnetf I, the lend dwnlr, have knowledge of the operator's plans
to dispole tli lbtld Wel:! oh th! lehd !nd I Specifically grant permission for the operation of the landfill.
I understand that both th! Ilhd AWhlt And tlperatot ere Iolntly end severalty liable for improper
operat ons en pttloer Ctosuf! of th! 1lndfill a9 provided for by North Carolina General Statute 130A-
309.27. 1 tUrthet Uhd!t!tlnd thlt Ndtth Carolina General Statute 130A-22 provides Tor administrative
penalties o� Up to � v! thou!!Rd soot[! 115,000.00) pet day per each violation of the Solid Waste
Managemint put!!, I lurthlr Uhdetltand that the Solid Waste Manacement Rules may be revised r.r
amended In {h! future end thlt t e acility llting end oper dons of this landfill will be required to
comply with All lucit tevilidnl et mind
/CH�+FC iI- ��FSfI� � �y
Frint Name IOwnlrl Sign lure IOwnerl Date
North Carolina
�( ,f`X �� County
I, `T�Pt'2t�'k��.4'10EfYYIn {mil. !Notary Public for laid County and State, do hereby cerify
Derr 5(nv �n � s Pcl ����iChqet q-I�lef7n.�essee �
that y p 9 �ersonaily�appeere��etore me us day and ac.nowledaed the
due e�cecutloh el th! torlooihd ihSttumint.
Witness my hand end ofilciel Teel, this the 01 %day of � 1�G�CIG�
IOfiic�al Seall J - Lam— '
otary Public
tviy comml<_sion e:rcires CX � //)O�� /JI �Q Y �
5 :GIiAP,�h,.,+,
A�,'p"R„y �2'
�iCF c�'�:
STATE OF NORTH CAROLINA-B RKE COUNTY
Th foregolnpp car�pficate o1 2� !'�
_��'li,b,�.., N P of said county Is adjudged
to be conect Le the�nstrument with ds certdicates be
re stared t �rll
yi 1))s -qay of 20.
�ll`�18_I A ETH T C,6Cst ODPER`lf ,��,— -- - - Deeds
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